Bill Takes On Health Issue In Small Steps

Senators Nancy Landon Kassebaum and Edward M. Kennedy today introduced the first major bipartisan health legislation of this Congress, a bill designed to require insurance companies to cover people with existing medical problems and to enable workers to keep insurance when they leave their jobs.

Senator Kassebaum, the Kansas Republican who heads the Labor and Human Resources Committee, said in an interview that she expected the panel to approve the bill before Congress goes on vacation in August, and that she hoped for floor action this fall.

The bill would provide the sort of incremental change that Republicans last year urged President Clinton to accept, instead of pushing hopelessly for sweeping legislation that would have reinvented the nation's health care system.

Senator Kennedy has long been a champion of proposals to insure all Americans, but he told the Senate today that "even though some people might consider this a modest step, I think it is an extremely important one." The Massachusetts Democrat explained in an interview: "In a perfect world, there is only one way to go, and that is the comprehensive way. But at other times, like this one, I try to see what offers the opportunity for progress. This bill will make life better for millions of people."

The bill would set health insurance standards, which states could make more stringent but not weaken. But the legislation also would apply to millions whose coverage states cannot regulate, by imposing requirements on the self-insurance plans many large companies have established. Self-insurance plans now cover about 60 percent of insured workers. The others are covered by policies bought from insurance companies.

The bill already has the sponsorship of 12 of the 16 members of the Labor Committee, from Senator Paul Wellstone, a Minnesota Democrat, on the left, to Senator Judd Gregg of New Hampshire and Senator Slade Gorton of Washington, both Republicans, on the right.

It was carefully written so that it would go to the Labor Committee, and not to the Finance Committee, which already has a huge agenda, is more conservative than the labor panel and has been less receptive to health care legislation in the past.

For that reason, the Kassebaum bill includes no provision for tax-deductible medical savings accounts, favored by many Republicans. As a tax measure, such a provision would have sent the entire bill to the Finance panel.

The insurance issues the bill deals with have been covered in just about every health care bill of recent years, although details of various proposals have differed widely.

For example, this bill contains a provision requiring any insurance company that offers individual policies to sell one to anyone who had group insurance coverage and lost it for any reason, from leaving a job to having his or her employer drop the coverage.

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Senator Kassebaum said she expected opposition from the insurance industry, but felt it was important that individuals not be allowed adrift without insurance.

Her expectation was confirmed when Faith Williams, vice president for Federal relations of the Health Insurance Association of America, said, "Even this kind of limited guaranteed issue will lead to higher premiums in the individual market" and would cause fewer people to buy insurance.

But she said the health insurance association, whose "Harry and Louise" television commercials last year against Mr. Clinton's plan played a significant role in its defeat, felt "that the bill looks at a lot of the key problems that everybody agrees are present."

"In several different areas it takes some very positive steps," she said. She praised Senator Kassebaum for making "a very strong effort to put together a balanced proposal."

The bill would also prohibit insurers from denying insurance to people with "pre-existing conditions." They could charge higher rates to people who came to them, with, for example, a record of treatment for diabetes or cancer in the six months before getting the new insurance. But they could only charge the higher rates for one year.

The bill would require employers to sell insurance to all employees who want it, and prohibit excluding any workers from coverage, as sick employees sometimes are. And it would ban employers from canceling coverage because employees get sick.

In contrast to the elaborate unveiling ceremonies for many health bills last year, this measure was introduced with hardly any fanfare. Mrs. Kassebaum made one brief speech shortly after the Senate convened, and Mr. Kennedy made another. They did not hold a news conference or have their staffs conduct a briefing to explain the plan.

Senator Kassebaum told the Senate, "I believe that the American people want us to work together to fix what is broken in the current system, without relying on big government solutions."

Senator Kennedy stressed the importance of this bill as a rare example of bipartisanship in this Congress.

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A version of this article appears in print on July 14, 1995, on Page A00018 of the National edition with the headline: Bill Takes On Health Issue In Small Steps. Order Reprints|Today's Paper|Subscribe